doh administrative order no. 2012-004 on the policy ......appendix 1 ta 7257-phi: public-private...

Appendix 1

TA 7257-PHI: Public-Private Partnership in Health Consultant’s Final Report

DoH Administrative Order No. 2012-004 on the Policy Framework for Public-Private Partnership in Health

Appendix 2


Design and Monitoring Framework

Design Summary (1)

Performance Targets and Indicators

(2)

Data Sources and Reporting Mechanisms

(3)

Assumptions and Risks

(4)

Comments/ Status

(5)

IMPACT Improved maternal and child health by 2015

Maternal mortality ratio of 81 by 2020 Under-five child mortality rate 26 per 1,000 live births by 2020 Infant mortality of 19 by 2020, by primarily focusing on reducing neonatal mortality

Provincial and national statistics and monitoring data Baseline surveys of beneficiary households conducted by independent contractor National Demographic and Health Survey (if provincial disaggregation is available)

Assumption Participating local governments are fully committed to MDGs 4 and 5 and provide the support and necessary resources to attain its intended impact and outcome Risk No PPP-related loans made before end of project due to policy and operational concerns

Only one loan (to Visayas Community Medical Center for construction and equipment acquisition) has so far been made mainly due to: interest rate issues; prospects of DOH financial grants to LGUs; and the coverage of the CBHCP (ie, only rural borrowers are allowed in the current program although there are efforts now to amend the coverage to include borrowers from urban centers). The risk also came about due to the reported slow processing of CBHCP sub-loan applications in the borrower’s institution. Furthermore, only one loan materialized to date due to: difference in priority or conflict between and among the LGU officials/executives; LGUs’ weak technical and financial capacity, particularly at the municipal level, to develop and implement the projects in accordance with ADB requirements; difficulty in securing documents/resolutions due to different political affiliations; and difficulty in securing Certificate of Borrowing which is one of the basic requirements of financial institutions in granting loans.

Appendix 1


Design Summary (1)


(2)


(3)


(4)

Comments/ Status

(5)

OUTCOME PPP modalities with demonstrated potential to increase the use of maternal and child health care referral services tested in the selected HPPP sites

Increased utilization of health facilities at the selected HPPP sites:

• percentage population using health facilities

• women delivering health facilities increased

• increased consumer satisfaction with health service performance

Local government records DOH statistics Project monitoring reports

Assumption Improved facilities will attract mothers to deliver in and refer their children to public health facilities Risk Participating government agencies are not able to secure full community engagement in program implementation

No PPP initiative operating at this time therefore monitoring of indicators may not be feasible. Instead the LGU should be made aware of the indicators.

OUTPUT 1 PPP modalities developed and promoted

Project proposal documents prepared in support of the identified and pre-cleared HPPP subprojects based on the diagnosis Business case, TOR and contracts for PPP projects be adopted by local government units

Project reports Contracts of PPP subprojects

Assumption Policy and operational issues have been cleared to guide LGUs and private sector in actual contracting DOH, PHIC,COA, NEDA PPP, etc approval of guidelines

The Provincial Government of Northern Samar adopted the business case, terms of reference, and draft contract, prepared by the TA team. Bidding has been conducted using the procurement rules prepared by the TA team. A PPP contract in the lease, operations and management of the pharmacy of Northern Samar Provincial Hospital has been awarded to Planet Pharmacy. The parties have set to meet for the pre-implementation meeting.

Appendix 2

Design Summary

(1)


(2)


(3)


(4)

Comments/ Status

(5)

Risk LGUs will be convinced by competing banks to take out loans LGUs hesitant on undertaking PPPs because it is a new approach Long or delayed process in rolling-out projects because of unfamiliarity with the process (ie, how to identify projects, how to bid out, how to award, contract negotiations, etc) Local government unit not deemed creditworthy by DBP (IRA is fully allotted as in the case of Camarines Sur) or is not interested in taking out a loan

The TA team prepared a PPP business case and TOR for the operations and management of a new hospital for the provinces of Saranggani and Camarines Sur. The governors of both provinces decided not to pursue the project in view of the political situation. In light of the above, the TA team has liaised directly with the following provincial governors: P Daza (Northern Samar); M Dominguez (Sarangani); and L Villafuerte (Camarines Sur). Adoption by LGUs may be a better performance target since adoption by national agencies such as DOH, NEDA, and COA may involve time-constrained processes requiring a period beyond the life of the TA. The TA team undertook field visits to Rizal and Bohol provinces for discussion on possible PPPH projects with key stakeholders. The TA assisted DBP in assessing the acceptability of procurement procedures of various entities applying for loan for hospital construction under the CBHCP (City Care Medical Center, Gentri Medical Center, Global Medical, Taguig Medical Center). The TA team reviewed and provided inputs on the initial seven loan application for birthing clinics submitted to DBP under CBHCP. The TA team drafted the Lending Guidelines for Midwives under the CBHCP for adoption by DBP.

Appendix 2


Design Summary (1)


(2)


(3)


(4)

Comments/ Status

(5)

OUTPUT 2 Incentives and operational strategies developed for PHIC in light of global budget system in support of PPP in Health initiatives

Written policy on global budget, PCC’s, and operational implications Recommendations for incentives to private and public small-scale health providers and facilities within a global budget Provide inputs for a suitable health M&E for global budget compatible with PHIC’s reporting, billing and payment PHIC plans and strategies for formal adoption of global budgeting and PCCs system as national financing

PHIC records Technical reports Project monitoring reports

Assumption At least one (1) LGU approved for inclusion in the initial implementation of global budget system Risk Global budgeting has not been started

The policy guidelines have been drafted and then approved by the PHIC Board. About 3 LGU takers/applicants so far. About 3 government hospitals have initiated application process. Global budgeting mechanics and M&E are included in a PHIC circular on global budget that has been released. The circular is targeting provincial hospitals.

OUTPUT 3 M&E established and capacity developed for promoting and implementing PPP in Health

Structure, policies, procedures of PHIC global budget systems monitored

Project monitoring reports

Assumption Long-term capacity development program launched through NEDA PPP, DOH, and DAP

The global budget system has

just been initiated such that

actual implementation is not

yet at a stage for actual

monitoring.

An M&E system is included in the guidebooks being developed by the TA for use of LGUs in their assessment of the performance of their PPP initiatives.

Appendix 2

Design Summary (1)


(2)


(3)


(4)

Comments/ Status

(5)

Capacity development framework for PPP in health developed and steps initiated to institutionalize and implement it through DOH Capacity building training provided to key government institutions and LGUs in implementing PPP health activities

Knowledge management activities conducted and KM resources developed

Risk LGUs’ concerns with Commission on Audit due to the absence of national policies yet on PPP. The LGUs can refer/consult with their auditors but with the conduct of actual post audit, the auditors may come up with Audit Observation Memorandum (AOM) containing several disallowances regarding the project (e.g., case of East Avenue Medical Center).

A Basic Course on Social Marketing and Knowledge Management for PPPH was conducted for the LGUs of Northern Samar (1-5 April 2012) and Sarangani (4-7 July 2012). A follow-up workshop for Northern Samar LGU to assist in the development of PPPH social marketing plan was held 28-29 May 2012. Through the course training and with inputs from the TA team, the Provincial Government of Northern Samar was able to develop a social marketing plan for the province’s PPPH projects. A capacity development intervention is currently being prepared for PHIC and DOH. The training module for PHIC is a practical course on communications and social marketing of PPP based on the findings from the training needs analysis. The TA and ADB assisted in the organising of PHIC Workshop on the New Global Payment Scheme at the ADB (16 July 2012). The TA team provided PPPH technical inputs in the workshop. The TA team provided PPPH technical inputs during the PHIC Public Relations and Marketing Forum in Clark Pampanga (3-5 September 2012).

Appendix 2

Design Summary

(1)


(2)


(3)


(4)

Comments/ Status

(5)

Two guidebooks have already been developed, namely, guidebook for PPP in pharmacy and guidebook for hospital management. Resource books for laboratory and diagnostics and birthing facilities are being developed. Monographs on financing options, legal/policy issues, and medical professional view of PPPH are also being developed. Three (3) brown bag seminars on PPPH were conducted (15 March 2012, 16 May 2012, 9 July 2012) with the support of Health CoP of ADB. The seminars gave an overview on PPP in health in the Philippines and discussed key issues and challenges such as policy and legal environment and leadership/governance challenges in PPP settings. The TA experts participated (primarily by giving technical inputs in the event or speeches) in various conferences / fora to promote PPPH: PPP in Health Investment Forum (21 June 2012, TA organized the event); 1st Easter Visayas Regional Governors Forum (18 July 2011); Health Summit for LGUs (9 March 2012); MDG5 Summit with Local Government Units and Health Secretary Ona (26 March 2012); Zuellig Forum (20 April 2012, TA set up a PPPH marketing booth). A regional learning event and marketplace on PPP in health will be held on 23-25 October 2012. Titled, “PPP in Health Manila 2012,” it will bring together about 220 policymakers, LGU executives, PPP experts and advocates, medical professionals, academicians, and health sector suppliers from Asia, Europe, and selected countries.

Appendix 2

ACTIVITIES INPUTS 1. PPP modalities developed and promoted. 1.1. Diagnostics conducted and recommendations

proposed for specific projects identified and pre-cleared by DBP, such as those covering:

1.1.1 Policy and regulatory matters governing PPP systems and procedures;

1.1.2 Financial environment and financing options including PHIC-related schemes; and

1.1.3 Procurement guidelines for PPP arrangements. 1.2 PPP in health subprojects developed and pilot-tested with the LGUs with DBP approval done through technical assistance in the following areas:

1.2.1 Project/enterprise development including formulation of robust financial models considering pricing policies and strategies, among other things;

1.2.2 Financing/health financing schemes and strategies under a PPP regime;

1.2.3 Regulatory/legal aspects in the light of the BOT law, Procurement Act, Local Government Code, and other governing policies;

1.2.4 Procurement and bidding procedures; 1.2.5 Capacity development including knowledge

management; and 1.2.6 Social marketing and communications.

1.3 Based on pilot-tested projects and recommendations, knowledge management resources and documents prepared, such as:

1.3.1 Financial models that will assist LGUs in capturing/choosing the best PPP in health arrangements;

1.3.2 Monograph on financing/health financing schemes and strategies;

1.3.3 Legal/policy notes/papers in the light of the BOT law, Procurement Act, Local Government Code, and other governing policies;

1.3.4 Procurement and bidding documents and templates; and

1.3.5 Manual/guidebooks on PPP in health applications such as pharmacy, laboratory and diagnostics, hospital management, etc. with citations of case studies on good/best practices; and an ePortal for PPP in health initiatives in the Philippines.

ADB (JSF): $1,000,000 DBP: $ 100,000 Total $1,100,000

Appendix 2

ACTIVITIES INPUTS 2. Incentives and operational strategies for PHIC in the

light of global budget system for PPP in health initiatives developed.

2.1 Global Budget scheme as a national financing strategy developed and initially rolled-out;

2.2 LOU system in the light of policy changes (including Global Budget scheme) within PHIC developed and initially rolled-out;

2.3 Accreditation policies, IRR, systems, social marketing, and procedures reviewed to facilitate private small scale health providers’ PHIC accreditation and access to CBHCFP; and

2.4 DOH, DBP, LGUs (in PPP subproject sites), and PHIC consulted and assisted to support the above activities.

3. M&E established and capacity developed for promoting PPP in Health.

3.1 M&E systems and proposed for the following: 3.1.1 PPP in health applications such as on pharmacy, laboratory, hospital management, etc.; 3.1.2 PHIC financial matters such as on LOU structures/systems, billing, and payment; and 3.1.3 PHIC organizational development matters such as on training, social marketing, and project implementation plans.

3.2 Training module on social marketing and knowledge management developed and pilot-tested in at least two LGU sites and one national agency (PHIC);

3.3 Long-term capacity development framework on PPP in health proposed; 3.4 Meetings (in support of 3.3) among stakeholders

initiated; 3.5 Regional learning and dialogue event for PPP in health conceptualized and conducted.

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